ethics of advertising strategies in the pharmaceutical industry1, The

Ethics & Medicine, Fall 2003

Generating business is, obviously, the raison d'etre of advertising. Its core concept is to present a new or renewed product in order to gain a market position or to maintain that of a product already launched. Advertising rests on the assumption, then, that in a market of competing products, a consumer is able to make a choice, which may be influenced through mainly conscious or subconscious channels or both, depending on the degree to which human nature is understood as mostly free or determined. Consequently, and more fundamentally, advertising, and especially its strategic use, may signal an attitude of superiority, since its recipients are regarded as individual instances of standard or at least predictable behaviour, whose desires and needs can be analysed and systematised. Hence, advertising presents archetypes of human life and its style, promising that a particular product will elevate or empower one to become or to remain what one ought to be. Key notions in forming these archetypes are, for example, 'independence,' 'youth,' 'health,' 'beauty,' 'status,' 'control,' 'affluence,' and 'pleasure.'

These general remarks are valid for pharmaceutical products, too, at least to the extent that they are produced for sale. There is a certain reluctance, however, to regard health as a mere commodity, since it is often, at least in Western culture, valued in conjunction with human rights, if not indeed identified as such, as examplified by European-type public health systems and their political and academic support.2 International conferences on health and human rights have stressed the universalist aspect of this claim.3 Interestingly, this reluctance is typically limited to medication or specific medical procedures per se, whereas other factors influencing one's health, e.g., the quality of food, clothing, and accommodation, are accepted as commodities relegated to the responsibility of the individual.

Similar to other simple qualifications, the notion of 'health' is interwoven with its contrary term, here that of 'disease,' one used in support of the other. It is not unusual, then, to define the term 'health' as it is done in the OED, namely as "the state of being well and free from illness in body and mind,"4 mirroring the traditional Christian definition of evil as the privation of goodness. From the experience of human contingency, the ideal and, hence, truly desirable human state is thus extrapolated. It is this antelapsian state that the advertising strategies of the pharmaceutical industry promise to recuperate for the patient, now finding herself in the entrapment of postlapsian contingency. It is, therefore, not completely surprising that pharmaceutical advertisements would carry religious overtones, for just as salvation religiously speaking is somewhat dependent upon means, advertising promises to provide such in order to overcome the contingencies humans may experience, be it in health, hygiene, nourishment, mobility, or social interaction.

Pharmaceutical products differ from others in three distinct ways. First, the potential user may only gain access to a specific product through his or her physician, since a (albeit shifting) number of these products are being administered through the channel of prescriptive procedures, intended to minimise the risk of disproportionate or other forms of inadequate use. Hence, the physician is the primary target for advertising on prescription drugs. Moreover, the actual customer is typically the health care provider on whose behalf the physician may act in selecting a drug deemed sufficiently appropriate. Fees paid by the patient are in this regard less an expression of a business transaction than of tax revenue. In public health systems, decisions on available drugs may also be taken on political grounds, which widens the scope of advertising strategies in this field, replacing advertising with its less eye-catching twin, lobbyism.

Second, pharmaceutical products serve the interests of financial, personal, and scientific gain alike: The producer expects a return of development costs and the generation of profit, the researcher wishes to explore or advance, the patient desires a greater state of health or well-being, and the physician may wish to comply with his own motives of altruity or power. This diversity of interests is somewhat revealed when new products are presented in medical journals or at academic conferences (co-) sponsored by the industry.

Third, the development of pharmaceutical products is particularly delicate, since they are designed to treat standard malfunctions in human beings showing individual traits, which at some stage requires testing on humans rather than, for instance, on animals. The desire to create "new safe medicines faster"5 (NSMF) and to custom-design medication increase the need for trials involving humans at much earlier stages of the research and development process, in part also to respond to concerns about animal testing.

Any ethical evaluation built on arguments rather than assertions depends on knowledge rather than mere assumptions. When analysing the advertising strategies in the pharmaceutical industry, gaining such knowledge requires transparence, since one can only understand what is clear to the mind. It is necessary, then, that even in advertising, transparent communication is used. This is somewhat analytically evident, for the industry has to comply with rules of ethical conduct and their legal interpretation governing all individual and juridical persons forming a society if it indeed intends to act ethically correct and in accordance with law, both attitudes stemming from free6 decisions subject to powers of internal or, in particular in the case of the latter, external enforcement. In other words, I contend that information on products be clear, true, and respectful.